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Carely – Helping Family Caregivers Partner with Providers

Posted on November 30, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Over the past year I have met many entrepreneurs who are or have created an app designed to help families better coordinate the care of loved ones. These apps all have similar features:

  • A Facebook-like interface that allows multiple family members to post medical/care updates and add comments
  • A calendar feature for important appointments and for coordinating care coverage by family members
  • An iMessage/Whatsapp-like messaging tool to communicate one-on-one with members of the family

Caring for a loved one and trying to coordinate family members is a daunting task so I applaud all of these efforts to make it easier.

However, I must admit that I come away after meeting these enthusiastic entrepreneurs a little disappointed. Their apps, while impressive, are stand-alone and are isolated from the rest of the healthcare ecosystem. For example, manual entry is often the only way to incorporate medical information from a provider and any communication with a healthcare organization needs to be rekeyed into the app.

Because of this, I was very excited when I ran into Michael Eidsaune, Founder and CEO of Carely at a recent conference. His company is taking a unique approach – instead of just focusing on family caregivers, his company is trying to bring caregivers and healthcare providers closer together so that BOTH benefit.

Below is a summary of our conversation.

What makes Carely different than other family caregiving apps?

With Carely, we didn’t stop at just trying to make things easier for families to care for a loved one. What we want to do is recruit families to be an active part of the care team alongside the healthcare provider. We don’t want families to be passive observers waiting for the next bit of news or have to log into those terrible “family portals” that don’t really give you any useful information or allow you to communicate effectively with the healthcare organization. We all hate using portals, it’s so one-sided.

For us it’s ultimately about getting the best care for your loved one not just about making things easy. In order to do this you need to get providers involved and not just families.

So why would a healthcare provider adopt Carely? What’s in it for them?

The provider-side of Carely is something we call Carely Community. This is something we built specifically for healthcare providers. It allows them to interact with families of the loved ones they are caring for. They can share information like when appointments are, what activities their loved one has been involved in and get feedback on those things from family members.

Long-Term and Post-Acute Care providers in particular have found that listening to family feedback can help them deliver better care. Through Carely they can get messages like “Mom seemed to have a little less appetite than usual today” or “Uncle Joe seemed a bit more confused than normal and had trouble getting to the toilet”. When the provider sees these messages in combination with the medical record, they can quickly make a determination as to whether this was something expected or something they need to look into. Having observations from family members over a period of time, helps to paint a better picture for everyone. A better picture equals better care.

The reverse is also true. If the provider can share updates with families, they can help reduce the number of phone calls they get. Imagine how relieved you would feel if the long-term care facility let you know that “Aunt Mary took part in the garden walk today” or “Dad ate everything at dinner tonight”. Those simple updates can help take worries away.

Is that what families get out of Carely? Less worry?

Carely Family is the app side of our business. That’s where all the tools are for families to coordinate and track their loved one’s care. Here you can see upcoming appointments, who will be visiting, etc. But the real power comes when the healthcare provider gets added to family’s care circle. Now the entire family can get updates on what’s happening and they can make better decisions together.

Take for example, Home Care. Typically Home Care is needed as a result of an unexpected event – maybe a fall or a minor accident. Arranging for Home Care puts a lot of stress on families and they all have to come together to make decisions. Without coordination there would be a lot of phone calls and texts flying around. If it were me I wouldn’t want to be getting 5 phone calls a day from people asking me how I was doing. So by bringing everyone together onto a single platform, including the Home Care provider, now all the information is up-to-date and the family can make the best decision possible.

Let’s talk about integration for a moment. Have you integrated with any EHR or other healthcare system?

We are currently working with PointClickCare. They have an API interface that will allow us to pull updates from their system and feed it through Community and onto Family. This makes everything seamless for the healthcare organization – they just continue to use PointClickCare and families get updated behind the scenes. Down the road we will look at how we can push information or notifications into PointClickCare. As well, we plan to begin integrating with the many other systems that exist in healthcare today.

What’s next for Carely?

I wish we could still be operating in stealth mode, but we’ve had such great feedback and interest in our product that we’re operating out in the open now.

We are continuing to iterate our product based on feedback from families and healthcare providers. We’re really making an effort to incorporate their requests. People want to use tools that they love to use. No one wants to use a tool that makes their life harder or that’s confusing. That’s why we’re spending so much time iterating our product. On one side it’s got to fit into the daily lives of families and on the other it’s got to fit into the workflow of the healthcare provider.

At the end of the day, our mission and vision is to drastically improve the caregiver experience and it’s our core belief that in order to do that we have to create an industry-wide solution, eliminate silos, get rid of useless “family portals”, and continue to innovate. This NEEDS to be done and I’m confident we’ll be the ones to successfully do it.

Transition to Value-Based Payments Top Concern for Long-Term and Post-Acute Care

Posted on November 12, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

On 1 October 2019, CMS will flip from a volume-based reimbursement model for Long-Term & Post-Acute Care Organizations (LTPAC) to a value-based one. This looming transformation was the top concern for most of the 2,000 attendees at PointClickCare’s annual user conference – #PCCSummit18.

PointClickCare makes a cloud-based EHR platform for LTPAC and HomeCare Organizations. According to the company, 60% of all Senior Living and Skilled Nursing Facilities (SNFs) in North America use their platform. Each year, PointClickCare hosts a user conference, called PCCSummit, where customers gather to get a preview of new features and to discuss the industry’s most pressing challenges.

Sweeping LTPAC changes by CMS

The top challenge on the minds of #PCCSummit18 attendees was, by far, the sweeping reimbursement changes being implemented by the Centers for Medicare & Medicaid Services (CMS) on 1 October 2019.  Referred to as the Patient Driven Payment Model (PDPM), it contains three significant changes for SNFs:

  1. A new value-based payment model
  2. Adopting ICD-10
  3. New reporting requirements

“The move to PDPM is going to be a challenge for everyone in the industry,” said Dave Wessinger, COO and Co-Founder of PointClickCare. “I think everyone will agree that moving from a volume-based reimbursement model to a value-based one is ultimately better for healthcare and for patients, but getting there is going to take some work. We are investing millions of dollars in product R&D, implementation resources and training to help make this transition as smooth as possible for our customers – who are all worried about PDPM.”

There were several sessions at #PCCSummit18 dedicated to PDPM. Each session was standing-room only.

A new value-based payment model

PDPM is the first step taken by CMS to shift LTPAC from a volume-based reimbursement model to one that is more value-based.

Currently, SNFs are reimbursed based on the minutes of therapy that patients/residents receive. The daily rate is determined by the type of therapy and SNFs are paid for as long as that therapy is administered. SNFs are required to conduct an assessment at pre-determined intervals to determine if further therapy is needed.

Under PDPM, CMS will base payments to SNFs on patient characteristics (diagnosis and comorbidities) rather than the type and duration of therapy being provided. According to CMS, there are several key advantages of this approach:

  • Removes therapy minutes as the basis for therapy payment (which may have encouraged some SNFs to provide unnecessary therapies to patients)
  • Enhances payment accuracy for nursing services by making nursing payment dependent on a wide range of clinical characteristics
  • Introduces payment adjustments that better reflect changes in resource use over a stay

Under PDPM, each patient/resident will be assigned a case-mix classification that drives the daily reimbursement rate for that individual. This classification is based on the diagnosis, acuity and characteristics of the patient/resident. Unlike the current payment model, the daily reimbursement rate is not uniform. It declines over time. This was done because evidence suggests that most therapies have diminishing returns the longer they are administered – unless the condition of the patient/resident changes.

The following slide illustrates the difference. It was presented by Genice Hornberger, RN, Senior Product Advisor at PointClickCare. The column on the left shows the uniform reimbursement for a 30-day SNF stay under the current RUG-IV payment model. The column in the middle shows what it the daily payments would be like under PDPM with accurate documentation.

Notice how the daily rate under PDPM starts off much higher at almost $915/day vs $631/day. This is in recognition of the work required of SNFs when new patients/residents are admitted.

The right-most column is very interesting. It shows the daily reimbursement rate for the case where patient documentation is inaccurate (ie: missing meds or missing patient conditions). This would result in $1,800 less under PDPM vs the current reimbursement model.

Adopting ICD-10

One of the goals CMS had for PDPM was to “promote consistency with other Medicare and post-acute payment settings by basing resident classification on objective clinical information while minimizing the role of service provision in determination of payment”.

To achieve this goal, CMS is mandating the adoption of ICD-10 standard in LTPAC. This will align long-term and post-acute care with their acute-care counterparts and make it easier for CMS to track Medicare patients moving between different parts of the healthcare system.

During the research and development stage of PDPM, found that almost half of SNF claims assigned generic ICD-9-CM codes as the principal diagnosis for residents in their care, which had limited usefulness in classifying residents. It also made it difficult for CMS to perform detailed analysis of LTPAC data.

Under PDPMD, ICD-10 codes will be used to map residents to the clinical categories that represent the primary reason for SNF care and are also sued for resident classification which determine the reimbursement rate.

New Reporting Requirements

Under the current reimbursement mechanism, SNFs are required to file patient/resident assessments with CMS 5 days, 14 days, 30 days, 60 days and 90 days into the stay. For longer stays, only quarterly assessments need to be filed.

Conducting, documenting and electronically transmitting these assessments requires a lot of time and effort by staff. In consultation with industry leaders, CMS is reducing the reporting requirements under PDPM.

Instead of regularly scheduled assessments, SNFs will now only be required to file a report when a patient/resident is admitted, discharged or has a change in condition. CMS expects to save itself $2B over the next 10 years from this reduction in paperwork and calculates SNFs will save on average, 183 hours per facility per year.

CMS tools to help transition

To help make the transition to PDPM, CMS has made several guides and online tools freely available to SNFs. One very useful tool is a customized analysis of each SNF’s current reimbursement vs future reimbursement under PDPM.

CMS used historic claims data from each SNF and corresponding acute-care data for patients transferred to SNFs (because only the hospital data had the requisite ICD-10 coding to determine the new patient/resident classification under PDPMD) to come up with an estimate of that SNF’s reimbursement under PDPM.

The analysis reveals that most SNFs would be at or above current reimbursement levels. A few therapy-heavy SNFs with non-complex patients will see lower reimbursements.

PointClickCare helping with PDPM transition

Given the importance of PDPM and the worries expressed by its customers, PointClickCare has created additional tools to help in the transition.

The team at PointClickCare smartly realized is the key to PDPM is having accurate documentation of each patient/resident. Any diagnosis, condition change or medication that is not documented will have a negative impact on reimbursements. Sandy Herbert, Senior Director of Product Management at PointClickCare explains:

“There is a hidden gap that could significantly impact reimbursements that we want to make our customers aware of. Through the CMS online tool, they can see an estimation of their reimbursement under PDPM, but baked into that estimation is an assumption of perfect documentation. Everything about the patient/resident needs to be captured and documented properly in the system – if anything is missed it means less money. However, with the change in classification method and the new reporting requirements, SNFs will have to be much more diligent in enforcing good documentation habits in order to maintain their level of reimbursement.”

At #PCCSummit18, the company unveiled an online PDPM assessment tool that calculates what a customer’s PDPM reimbursement would be based on the actual documentation in the system. In most cases, this amount is below the amount the CMS estimate.

In her presentation Hornberger showed an example of how significant this gap can be (see slide above). For a typical 30 day stay, PointClickCare found that certain aspects of the record were not coded properly which would result in a smaller claim being submitted to CMS. Their analysis showed that on average, a SNF would only receive $17,100 for that 30 day stay versus $18,900 under the current system and well below the $19,600 that would be possible under PDPM.

PointClickCare has made their assessment tool – PDPM Risk Assessment – freely available to its customers. Their team of consultants are also working with customers to address the gaps that are identified by the free assessment.

“PointClickCare has a history of working well with clients, especially when it comes to data,” said Timothy Carey, Director of Data and Performance Analytics at BaneCare. “Having the right data available to our leadership is critical. It’s what we need to help improve our processes and workflows. As far as I’m concerned, data from the PointClickCare system is like gold. It shows us where things are going wrong and where we can improve.”

Judging from the smiles on the faces of attendees who got a preview of their customized PDPM Risk Assessment at #PCCSummit18, the data is clearly reducing the anxiety around the transition.

Finding Quick Wins by Creating Amazing Patient Experiences

Posted on October 24, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

In this tight environment, it is important to demonstrate quick wins for your HealthIT projects. One of the best ways to do this is to demonstrate improvements in patient experience. Don’t worry, even infrastructure projects can help patients.

Patient experience is very important right now. Competition is intensifying and patient experience is one of the key factors influencing where people go to receive care. The better your organizations’ patient experience ratings, the more likely patients are to come through the doors. Improving patient experience is, therefore, one of the best ways to help your organization improve its bottom line.

There are many ways that patient experience can be improved:

  • Minimize wait times
  • Offer “consumer-like” conveniences – like online appointment booking, electronic communication with clinicians, video discharge instructions, etc.
  • Provide convenient access to medical records
  • Treat patients with empathy and respect
  • Streamline administrative workflows/processes
  • Reduce stress and frustration on clinical staff

The last two items in the list are often overlooked by healthcare organizations, yet I would argue they represent some of the biggest opportunities to improve patients’ experience. Luckily streamlining workflows and reducing staff frustration are two areas where Healthcare IT departments can have a positive impact.

With healthcare budgets under pressure from changing reimbursement models and rising operating costs, it is harder than ever to build and sustain support for HealthIT projects. IT leaders need to show that their project will have a positive impact and demonstrate quick wins or risk having their projects cut. Thankfully, linking your project to improved patient experience isn’t difficult. It just requires a little forethought and elbow grease.

As an example, consider the “lowly” single-sign-on project (SSO) – implementing a tool that consolidates user credentials into a single platform. In most organizations this type of project is met with glazed eyes and is viewed as purely an endeavor by IT to upgrade the hospital’s infrastructure. As such, it is an easy project to cut. However, this project does have an impact on clinical staff. SSO can eliminate the need for users to log into each application separately, a significant frustration and time waster. Even better, most SSO platforms today include biometric user log-on, eliminating the need to remember complex passwords, another common frustration. When you reduce staff frustration and save them time, it means they are in a better position to provide a better patient experience. It is therefore not a stretch to say that SSO can improve patient experience.

If you look at your HealthIT projects with a patient experience or staff-relief lens, my bet is that you’ll find many can have positive benefits on both. It may take a bit of digging to find the connection but I believe it is there.

Having said that, not all projects will have the same positive impact for your organization. Thus, what’s needed is a way to compare the relative impact of each project so that you can easily see which would provide the biggest bang for your investment.

One way to do this is to use a relative score to compare projects. Below is an example of a simple scoring mechanism you can use.

For each HealthIT project rate them on 0-5 scale with ‘0’ = no impact whatsoever and ‘5’ = a bottle of champagne will be waiting for you at your desk from end-users or patients who are ecstatic with the improvement. To what degree does this project:

  1. Improve patient wait times while in the facility?
  2. Increase access to medical records for patients?
  3. Help patients gain access to information or individuals on their care team?
  4. Promote empathy and/or respect for patients?
  5. Decrease the total length of stay in the facility?
  1. Decrease the paperwork required by staff?
  2. Eliminate unnecessary steps in an existing process?
  3. Remove a long-standing end-user frustration
  4. Give time back to clinicians that they can put towards more productive use?
  5. Help improve the work environment for staff?

The first set of numbered questions are directly related to the patient experience, while the second set of lettered questions are related to staff improvements. Each project should have two scores, one for direct patient impact and the other for staff impact.

The questions above are by no means exhaustive and you should include criteria that is most relevant to your organization. For example, if your organization has placed an emphasis on 5-star online ratings, then you should add that question to the set of numbered questions.

Please keep in mind that this scoring mechanism is only meant to help you compare projects relative to one another. It is not meant to be a universal standard for scoring IT projects in healthcare.

Once you have scored your projects, rank them in descending order and you will get a sense as to which ones potentially provide the biggest patient experience impact. Those are the ones that will be more easily justified AND are the ones most likely to gain inter-departmental support. PRO TIP: Don’t just evaluate the projects yourself, ask other department leaders/stakeholders to score your projects too and incorporate their scores into the overall rankings.

Assessing the impact on patient experience and staff stress is just the first step. Once your project gets green-lit you now have to show your project can produce quick wins. This is where the elbow grease comes in. Take the questions where the project scored 3 or higher and turn those questions into a survey. Have patients and staff use the same 0-5 scoring system to provide feedback to you BEFORE the project starts so that you have a baseline. Then use the same survey to get feedback on the project at appropriate milestones (you don’t always have to wait until the end).

You may encounter some resistance to polling patients, but the survey need not be a formal document. You could simply ask staff to ask patients what they think of the project (ie: Mr. Smith, on a scale of 0-5, what do you think of our new portal’s ability to give you access to your medical record?).

Use the collected data to show the progression of the project and the impact it is having on patients and staff. It is important to share as much information as you can about your project, even if the results aren’t glowing, show that you are taking the feedback and making adjustments.

To learn more about how to assess your HealthIT projects for quick wins and improvements to patient experience, join me on this free upcoming webinar Thursday November 8th at 2pm ET. This webinar is hosted by AAJ Technologies. Together, myself and Murry Izenwasser of AAJ will be diving deeper into this topic. Register today!

AAJ Technologies is a proud sponsor of Healthcare Scene.

Infographic – Practical Interoperability in Healthcare

Posted on October 22, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The team at HULFT sent me their new infographic that identifies the stakeholders that should be “at the table” to set your organization’s data sharing and interoperability policies.

There are a couple of things I really like about this infographic.

First, I like the mixture of disciplines and backgrounds that HULFT has identified as data stakeholders. There are people you would expect to see around the table like the CIO, CSO, Privacy Officer, COO, etc. But there are others who are a bit of a surprise: the Revenue Cycle Manager, Pharmacy Benefits Leader, Nurse Practitioner Informaticists, and Care Management Director.

The Care Management Director is an especially welcome inclusion. Without interoperability coordinating patient care is time consuming, frustrating for everyone involved and fraught with errors (medicine reconciliation anyone?). When I think about the need for interoperability, care coordination is what come springs to mind.

The second thing I like about this infographic is the consistency of the visual. The avatars seated at the miniature table at the top are the same as the enlarged versions underneath. This attention to visual detail appeals to the healthcare marketer in me.


Mandatory Nurse Ratios – Good for Massachusetts?

Posted on October 18, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

On November 6th, Massachusetts will vote on mandatory nursing levels. Proponents cite burnout, injuries and patient safety as reasons to vote YES. Opponents claim ERs wait times will rise, small hospitals will close and patient bills will increase.

There is no better way to get a sense of what is on the minds of healthcare leaders than talking with fellow conference attendees. At the recent SHSMD18 event, I had the opportunity to attend a social gathering hosted by the New England Society for Healthcare Communications (NESHCo). There was one topic that dominated the discussion – the upcoming vote on November 6th on mandatory nursing levels in Massachusetts.

Mandatory nurse ration has been a hotly debated issue in the state. Voters will now decide if the state will forge ahead with plans to “limit how many patients could be assigned to each registered nurse in Massachusetts hospitals and certain other health care facilities.”

The proposed MA law sets specific limits on the patient-nurse ratio. For example:

  • 3 patients per nurse in units with step-down/intermediate care patients
  • 1 patient under anesthesia per nurse in units with post-anesthesia care or operation room patients
  • 5 patients per nurse in units with psychiatric or rehabilitation patients

The vote has pitted the Massachusetts Nurses Association (the nurses union, MNA), which strongly supports mandatory nurse ratios, against the Massachusetts Health and Hospital Association (MHHA).

The MNA cites numerous studies, like this one from 2016, that shows for every patient added to a nurse’s workload, the likelihood of a patient surviving cardiac arrest decreases by 5% per patient. And  this one from 2017, that concluded “Exposing critically ill patients to high workload/staffing ratios is associated with a substantial reduction in the odds of survival.”

The MNA has mounted a sizeable campaign to convince MA voters to vote YES. Their website, is full of interesting articles, stories from frontline nurses and quotes from physicians that support the measure.

The MHHA, on the other hand, is encouraging a NO vote. They acknowledge that nursing levels need to be monitored but imposing strict limits based solely on the unit or patient type will cost nearly $900 million every year. According to the MHHA, patients would end up footing the bill through higher healthcare costs.

The MHAA also claims that specifying the maximum number of patients for each nurse, effectively puts a cap on the number of patients a hospital can accept in their ERs – resulting in longer wait times.

For an excellent overview of the law and the arguments both for and against Question 1, check out this excellent article by Boston’s local NPR station – WGBH. The article also has information about the impact mandatory nurse ratios has had in California which enacted a similar law back in 1999.

What I found fascinating about the discussions with NESHCo members was how hospitals in neighboring states were also voicing their concerns on Question 1. If MA was to mandate nursing ratios, that state’s hospitals would suddenly need to hire thousands of nurses in order to comply with the new law. Where would these nurses likely come from? You guessed it, neighboring states like New Hampshire, Maine, Vermont and Connecticut. It’s easy to see why hospitals in those states would be worried.

I honestly don’t know which way I would vote.

On one hand the current working condition for nurses is unsustainable. Nurses are often asked to work longer shifts because hospitals can’t fill open nursing positions fast enough and most are expected to work without breaks. Could you imagine working 12hrs or more without being able to eat or go to the restroom? 70% of nurses are already feeling burnt out in their current positions. Clearly the status quo isn’t working.

On the other hand, there is currently no provision in the law to adjust the nursing ratios as technology advances. New York Presbyterian Hospital, for example, has built a remote patient monitoring center that tracks patient vitals in real-time. Using a combination of AI, specialized technicians and remote nurses, this “command center” can alert the local nursing staff when a patient may be experiencing an issue. Armed with this technology, not only are patients safer but on-site nurses can spend more time with each patient in their unit. The MA law would have the unintended consequence of squashing investment in this type of technology since staffing levels could not be significantly adjusted.

For more on this topic, take a look at the transcript for this week’s HCLDR chat. Government regulation is also the topic for this weeks’ #HITsm chat hosted by John Lynn. Join the discussion Friday 10/19 at noon ET.

Nurses need help. Mandatory nursing ratios is one possible solution. However, I’m not sure legislation is the best way to improve the nursing situation.

Rolling Over Mountains – An Interview with Niko Skievaski, President of Redox

Posted on October 16, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Over the past year I have been following the success of Redox and I have read many articles about the entrepreneurial journey of their President and Co-Founder, Niko Skievaski. I recently had the chance to sit down with him at the MGMA18 conference in Boston.

Rather than revisit the same questions that have been covered in dozens of other articles, I wanted to go in a different direction. I wanted to learn more about Skievaski- the-person rather than Skievaski-the-entrepreneur and I wanted to hear Skievaski’s opinion on the state of the healthcare as an ecosystem.

The latter is something that we have been investigating here at Healthcare Scene. For more details, see John Lynn’s recent post about MEDITECH’s app development environment (Greenfield) and my article exploring whether EHR companies are difficult to work with.

Skievaski and I had a wide-ranging conversation. I hope you enjoy it.

You and I met briefly at the Redox party at HIMSS18 earlier this year. I just want to thank you for your hospitality.

You’re welcome. We love our taco parties at Redox. I’m glad you enjoyed the fiesta.

I understand that you recently moved from Madison, WI to Boulder, Colorado. Why the move?

I lived in Madison for 10 years. I was working for EPIC during that time so it made sense to be there. But I recently decided that I needed a few more mountains in my life so I moved to Boulder.

All through college I raced mountain bikes and I wanted to get back to that. Madison does have a few rolling hills which are fun to ride down, but there’s no comparison to biking down a mountain. So I moved to Boulder for the mountain biking.

You’re from Canada right? [Yes] I was up in British Columbia for two months in the summer last year just mountain biking the trails up there. That was my first real experience being in Canada for an extended period of time. It was fun. You guys are really chill up there in Vancouver.

There are many players in the data integration space. Some have been in the business for decades. Why has Redox succeed in capturing the buzz while others haven’t?

We do things fundamentally differently than existing vendors in the integration space.

In the status quo, you implement an EHR and you need upwards of 400 interfaces to connect it to various other systems in your hospital. So you go out and hire 5-20 interface analysts to sit around all day and code the interfaces you need. You do that a few times, like we did at Epic, and you realize that you are building the same interface over and over again for different health systems. It is literally is the same interface.

Redox is based on the premise that you only should have to build the interface once for all healthcare systems. Once it’s built, others can leverage that work too. For example, we connect Brigham and Women’s ADT feed to Redox. We mapped it. We know where all the fields are. And we’ve done the same with hundreds of other health systems. So if there is any reason that Brigham wants to share their info with any of those other health systems we can facilitate it very easily.

Legacy players didn’t grow up in the cloud so they don’t think like we do. They come from a world of on-premise integration and at a time when healthcare organizations wanted to do all the interface work themselves. It’s a different world now.

I guess you can say that we’re getting the attention because we are solving the problem so differently than everyone else.

One of the interesting things about Redox is that you don’t sell to healthcare organizations. Instead you focus exclusively on HealthIT vendors. Why is that?

We started by working with HealthIT startups that knew how to build in the cloud but didn’t know anything about HL7 and didn’t want to. Yet these companies needed to connect to their customers’ EHR systems.

Without that integration, healthcare organizations wouldn’t buy these amazing cloud apps because of the lack of easy connectivity to their existing systems. In that equation, the incentive lies with the HealthIT company. They are the ones that want to solve the issue of connectivity more than the healthcare organization does. So we target companies that need this help and we go to their customers, get connected to the data and make It easy for the new company to focus on what they do best – which isn’t data integration.

The first project we do with a health system is very much like a standard integration project. The second project is where things get excited because we use that exact same interface we built the first time. There’s really no work to be done by the organization. That’s how we scale.

Is there an ideal type of HealthIT company that Redox likes to work with?

With certain vendors who have the right multi-tenant architecture, like PointClickCare, we can just connect with them once and they can then provision to their customers with a flip of a switch. Any PointClickCare location that wants integration, they can just click and make it happen. Together we make it very easy for a PointClickCare customer to connect with HIEs and the healthcare organizations that they work with.

Basically any HealthIT vendor that is truly cloud-based and that has embraced the concept of having a single platform for everyone is an ideal fit for Redox. Of course, we’re willing to talk to anyone to try and find a solution, but if you are cloud-based HealthIT vendor we should really be talking.

Can you give me an example of an advantage Redox enjoys because you are cloud-based?

By being in the cloud we essentially become the cloud interface for health systems to connect to cloud apps. Vendors come to us because we make it easy for them to get the data they need. Healthcare organizations push cloud vendors they want to work with to us because they won’t have to do any work to connect that new app if that vendor signs on with Redox.

Where things get really interesting, and exciting for Redox, is when we can use our cloud platform to facilitate conversations between vendors and their common customers without the need to go all the way back to that customer’s EHR as the focal point of integration.

For example, say there is a cloud-based scheduling app that allows patients to see and book appointments online. Let’s say they are a Redox customer. Now let’s say there is a telemedicine app that allows healthcare organizations to offer telehealth visits and it reads/writes appointment data directly into the organization’s EHR. Say this telemedicine company is a Redox customer too. So if the healthcare org wants to offer Telemedicine appointments through that scheduling app, the two companies can just integrate through Redox rather than use the EHR as the point of integration because we have all the necessary information running through our platform. This would speed up the transaction and make the patient experience more seamless.

This level of integration is just not possible without being in the cloud.

One of the topics we have explored recently at Healthcare Scene is how difficult it is (or isn’t) to work with EHR companies like Epic, Cerner and Allscripts. What are your thoughts on this? Are EHR companies hard to work with?

I would say, in general, EHR companies get a bad rap. I worked at Epic and I have to say that being inside Epic you don’t realize that people outside think you are difficult to work with. We worked hard to give our customers good service. Epic supports their customers, which are health systems. If a system wants to integrate with an application, then Epic people are more than happy to make it happen. They will put together a project team to support that initiative.

I think that as long as the health system is driving the conversation, EHR companies can be easy to work with.

The challenging part is when there is no customer in between. Say you are a HealthIT vendor and you want to go strike up a deal with an EHR company, like Epic. You have to realize that it’s nearly impossible for that EHR company to assess you as HealthIT vendor. They can’t tell if you are a good vendor or a bad one. If you are an established player or someone with an idea on the back of a napkin. The only way they can tell is if they go ask their customers – the health systems. Because of this, their traditional response has been: “Yes, happy to work with you, but we need to have one of our customers on board to prove this will work.” This can be perceived as being difficult to work with.

When we started Redox we didn’t go immediately knocking on Epic’s door and asking our friends to partner with us. Instead we went out and found a mutual customer to work with so that we would have a proof point when we did approach them.

I actually think it is easier to work with large EHR companies versus smaller ones. The larger companies have more invested in each of their customers and are more apt to work on projects that their customers want to do. Smaller EHR companies are constrained by resources and often don’t have the infrastructure to support integration projects in a timely manner. The good news is that things are changing. We’re seeing a lot more of the small EHR companies come out with developer programs, APIs and partner exchanges. I think they understand the need for their systems to be open.

Is the lack of interoperability a technological issue or is it simply an unwillingness to collaborate?

Neither. It’s a business model problem.

There is no business model that drives healthcare organizations to share their data. No one bats an eye about the lack of interoperability in the consumer world. Walmart doesn’t share their customer data with Target even though there are many people buy from both retailers. If they did share data, they would just be stealing each other’s customers. Healthcare organizations are in competition with each other so they aren’t really incentivized to share data with each other, but give them a useful app in between and all of a sudden they will open up their data.

Interoperability is the right thing to do, but it’s a hard thing to do.

What do you wish you could do with an EHR company that you cannot do today?

The user interface (UI) of EHRs are locked down. I wish EHR companies were more open to change workflow or add buttons to their UIs to make things a more seamless.

I totally understand why they don’t allow it. The workflow in an EHR has an impact on patient safety as well as on outcomes, so you wouldn’t want just any vendor to be able to make UI changes on a whim. But it would be great if there was a way to do something with the UI to make it easier for the end user.

For example, if you are doing something in the workflow, it would be fantastic if you could add a button to the UI that launched a 3rd party app from within the EHR. Say a clinician is doing a chart review and they want to be able to see the latest data from a remote patient monitoring tool. Imagine if that clinician could click a button and launch the actual monitoring app rather than that app having to ship its data to the EHR and have it stored/rendered in a poor format – like a table of numbers or a rudimentary chart. Why not let the native app show the data in all it’s glory using an interface designed specifically for it?

What’s next for Redox?

We want to push the healthcare industry to a point where we don’t even think about integration anymore. We want to see an end to integration projects. Think about all the time and resources that would be saved if you don’t have to use a custom interface each time. If we can do that we can drive down the cost of healthcare for everyone. To do that we just have to keep growing the nodes on our network and be a good partner to everyone.


This may sound like a tall order, but maybe not for someone who rolls over mountains on a bike for fun.

[Update: Niko Skievaski’s title which was incorrectly reported as CEO. Skievaski is Redox’s President and Co-Founder]

MGMA 2018 Keynotes Hit Back-to-Back Home Runs

Posted on October 2, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Not far from legendary Fenway Park, MGMA hit back-to-back home runs with their opening keynotes: Simon Sinek and Mel Robbins. Both had us completely enthralled and hanging on their every word. It was an incredible way to start a conference.

I have never been more excited for a set of keynotes than I have for the 2018 MGMA Annual Conference #MGMA18Annual. When the agenda for the conference was officially released I was pleasantly surprised to see not one, but TWO well-known keynote speakers.

Simon Sinek is best known for his TEDTalk – “How great leaders inspire action” which became one of the most popular ever produced. In it Sinek talks about getting past WHAT you offer and HOW you offer it in order to reach the crucial WHY you do what you do. It is one of my favorite videos to watch.

Sinek’s #MGMA18Annual keynote was based on his latest work on Finite vs Infinite Games of Leadership. For a preview you can watch this video of his presentation at Google.

According to Sinek a finite game is one where there known players, fixed rules and an agreed upon objective. Baseball, football and hockey are classic examples of finite games. Infinite games, have known and unknown players, changeable rules and the objective is to keep the game going. With infinite games there are no winners or losers. The only way the game ends is when the second-to-last player loses the will or the resources to continue playing the game.

Sinek used the Cold War as an example of an infinite game. The Soviet Union was the second-to-last player and they dropped out when they lost the will and the resources to keep playing. Sinek warns that when you pit a finite player vs an infinite player you are in fact playing an infinite game and inevitably the finite player loses. That is because the finite player is playing to WIN whereas the infinite player is playing to keep playing. Sooner or later the finite player will drop out – not prepared to dedicate as much resources to the game as the infinite player.

Sinek applied this finite vs infinite game analogy to business and found that too many companies are finite players in an infinite game. “We talk about being number 1.” said Sinek. “We boast about beating the competition, but in fact that isn’t the case at all in business. There is no winner. You are either ahead or behind, but you can’t actually win in the game of business. You just have to keep playing.”

According to Sinek, one of the keys to succeeding in an infinite game is to have a Just Cause. Such a cause will help you rally the necessary resources and will to keep playing the game. Ending child poverty, and making the sum total of human knowledge searchable are examples of Just Causes.

Healthcare clearly has a Just Cause – to help people live longer, healthier lives. So why is healthcare in such a quagmire? (something Sinek claims is typical of finite players in an infinite game). This was one of the questions posed by a member of the audience at #MGMA18Annual. Sinek’s answer was brilliant.

“I believe that the problem in healthcare is that many organizational leaders have mistakenly taken the industry’s Just Cause and made it their own. Healthcare as industry is supposed to keep people healthy. However, the job of the leaders of healthcare organizations isn’t to make people healthy. No! Their job is to take care of the people who deliver care to patients.”

Imagine how different healthcare would be if administrators, healthcare leaders and government officials all had the same goal: taking care of the physicians, nurses and support staff under their influence. Think about the level of care a patient would receive if the doctor and the nurse felt that the organization they worked for had their back? How different would the patient experience be?

Home Run #1.

Mel Robbins, #MGMA18Annual’s second keynote speaker, kicked off Day 2 of the conference with a rousing session centered on her transformative 5 second rule. Her simple rule has helped people stay sober, save their marriages and turn-around failing careers. The rule is so simple that she felt obligated to call it out in her opening: “After I tell you the secret of the 5 second rule, most of you will likely say to yourself – that can’t possibly work, but trust me it does. And that’s the beauty of it, it’s simple.”

In a nutshell, Robbins method involved counting down from 5 whenever you find yourself starting to have a negative thought or when you feel yourself making an excuse NOT to do something you know you should.

Roll out of bed and see your running shoes, but then look outside and see that a few dark clouds. Don’t let the excuse fully form in your mind. Instead, change your mental soundtrack by counting down 5 – 4 – 3 – 2 – 1 and then do it. See a task that you’ve been putting off all day, 5 – 4 – 3 – 2 – 1 and dive in. Sounds too simple right?

Robbins spent much of her time on stage giving scientific evidence and examples of how this 5 second rule actually works. She talked about being on “autopilot” – a mental state where your brain falls back on learned behaviour to guide the actions you take. Procrastination and self-doubt are the autopilot settings for most of us. According to Robbins, in order to break free of autopilot, you need to engage your frontal cortex – which is what happens when you count down from 5.

This simple brain hack puts you back in control of your actions and suddenly the excuses melt away and you get on with the necessary task. That essay suddenly gets written, the house gets painted, the phone call gets made and the important email gets sent.

Robbins was quick to point out that her 5 second rule did not apply to life-or-death medical decisions, nor should it be used to make important financial or life-altering decisions. It was meant to be used when we start hearing the voice of our inner doubts.

I must admit that when I first watched Robbin’s TEDTalk I did not internalize her message. I fell into the trap and thought it was too simple to be effective. Hearing her deliver her message live at #MGMA18Annual changed my mind. It’s only been a day but already I’ve used Robbin’s 5 second rule to climb the stairs instead of using the escalators at the convention center, opt for water instead of soda,  and write this blog before going to bed.

Home Run #2

Thank you MGMA organizers.

2018 Thrival Festival. Are We Asking the Right Questions?

Posted on September 26, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Presentations in a botanical garden. Workshops in an actual work shop. Disco in a museum. The 2018 Thrival Festival eschewed tradition and challenged attendees to ponder: Are we asking the right questions when it comes to humanity + technology + art?

The annual Thrival Festival held in Pittsburgh PA is truly unique. It combines art, technology, philosophy, music, and yes, even healthcare, into an event that is part science fair and part theatre. Instead of holding the event in a traditional auditorium or hotel, the organizers chose the beautiful Phipps Conservatory and Botanical Gardens as the setting for this year’s event.

Rising like a glass armadillo out of lush grass splashed here and there with colorful flowers, the Conservatory welcomed attendees with a warm scent of green leaves and rich earth. It was immediately apparent we were in for something different as we passed through the mammoth glass entryway and wound our way through the maze of monarchs and waterfalls to reach the main session room.

With sunshine and mother nature as a backdrop, Thrival kicked off with a keynote from John Battelle @johnbattelle, CEO and Editor-in-Chief of WIRED. Battelle wasted no time in setting the tone for the day. Early in his presentation he put up the following picture from National Geographic with the caption: What makes us human?

© Martin Schoeller/National Geographic

The image was from National Geographic’s October 125th anniversary issue (2013) where they photographed the new faces of America – a reflection of the blurring of traditional racial and ethnic lines. Battelle used the slide to highlight that society will soon be challenged to define humanity more broadly than before – as we manipulate our genes, embed technology into our bodies and program human-like qualities into robots.

Later in the morning, the issue of do-it-yourself implantable devices and pseudo-scientific injectable cocktails was discussed by a panel of experts. Dr. Rasu Shrestha @RasuShrestha was asked: Is biohacking the future of medicine? With a smile and wink, he deftly answered the question by putting forward the notion that the original healers and physicians were themselves the biohackers of their day. Instead of nanobots they used herbs and crude instruments to try and cure our pre-industrial ancestors.

*Yes, Rasu did use “OG” in his answer, to the delight of the audience.

The panel also featured Rich Lee @lovetron9000 the controversial sex technologist who not only installed a vibrating implant in himself but also recently self-injected a gene therapy that he hopes will cure him of his color blindness. Vilified by authorities, Lee was decidedly normal both on and off the stage answering questions about his motivations.

Over lunch I had the opportunity to chat with Laura Montoya, Founder of Accel:AI and Director of Women Who Code. Montoya teaches development teams to consider the ethical issues relating to AI algorithms. She posed the most interesting question of the day: Would you get into a self-driving car if you knew the algorithm governing it would choose to save the life of a pedestrian over you the passenger?

“Think of it this way,” explained Montoya. “When you sign up for a ride-sharing service, you have to agree to the company’s terms of use. Buried in that agreement is a waiver of liability. Essentially you as an individual are opting into the fact that you are okay with being driven around by a computer rather than an actual driver. The liability of the company for you is therefore limited. Now think about the pedestrian. They have not opted into the company’s self-driving car. They have not agreed that a self-driving car should be in their neighborhood. Therefore, the pedestrian represents a potentially high financial liability – being an innocent bystander. So if the car is faced with the choice of crashing into the pedestrian vs crashing into a tree, would the difference in the degree of liability influence it’s decision. And if it did, would you have knowingly gotten into the vehicle in the first place.”

*Note to self, uncheck the self-driving option from my Uber app.

My Thrival afternoon began with a short viewing of GAPPED – a documentary from Molten Media Group. The excerpt contained powerful and moving interviews of Pittsburgh residents who were in danger of being left behind by the innovation boom that the city is currently enjoying. After the screening, the producers of the film shared that they were seeking to answer a single question: Will Pittsburgh and its people have the chance to rise together or will those unwilling to adapt be left behind?

To me the film asks a much broader question: What happens when innovation wealth is unequally distributed within an ecosystem? And I don’t mean the spoils of innovation like money, equity stakes and fancy offices. What happens when public and private programs inadvertently leave out a portion of the local population? Is it fair that 95% of the innovation seed funding goes to middle-class college graduates while innovators living under the poverty line struggle to keep afloat? I can’t wait to see the entire film when it is released later this year.

I decided to end my Thrival day by attending the Moonshot Workshop led by the XPRIZE Foundation – the people behind the space competition that spawned Virgin Galactic and SpaceX. The workshop started with a short presentation by Amir Banifatemi, AI Lead at XPRIZE. Banifatemi explained the process they go through to curate, refine and define the incentive competitions that “entice the world to take action”. It turns out that it takes the team at XPRIZE over nine months to clearly define one of their challenges.

“If we define the challenge too broadly, teams become overwhelmed with where to start.” Said Banifatemi. “Problems need to be specific enough to spark the imagination but not so blue-sky that people get lost in the possibilities. If we make our challenges too difficult, we may discourage people from entering. It turns out that coming up with the right question, the right challenge is almost as hard as solving it. But if you get the question right, magic happens.

Banifatemi’s statement was the perfect bow on my day at Thrival Festival. Before innovation can happen, a problem or challenge must first exist. Once we understand that problem, our collective imaginations can be unleashed. Better definition of the problem leads to better innovation. The question of: “How can we look inside the human body?” begat X-ray machines. The more refined question of: “How can we look inside the human body without causing harm to the person and with sufficient detail to see tissue?” begat MRI machines (okay maybe a bit of a stretch, but you get the idea).

As the high-energy techno anthems from Veserium washed over me at the Thrival evening event, I found myself thinking about all the questions we are asking in healthcare. Perhaps we need to take a moment and ask ourselves if we are really asking the right ones.

Are EHR Companies Difficult to Work With?

Posted on September 10, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

There is an entrenched myth that EHR companies are difficult to partner with – more interested in up-front partner fees and revenue sharing than actually collaborating with 3rd party companies. Two companies are working hard to be different.

Early in the spring, I had a lengthy conversation with a group of vendors at HIMSS18 about partnering with EHR companies. I had stopped at a booth and somehow we got onto the topic of collaborating with EHR companies as a way to accelerate product development and sales. The person I was speaking with was very frustrated at the lack of response from three of the larger EHR companies. I’m paraphrasing, but her statement was essentially this: “All they want is to charge me their 5K partnership fee and then take 10% of everything I sell to their customer base. It’s ridiculous.”

At that point, several representatives from surrounding booths joined in our conversation. All of them had similar frustrations and shared similar stories of being shunted to the partnership team – which in their opinion was just a sales team in disguise – where they were told about all the wonderful benefits they would receive in return for an upfront partnership fee. I’m sure many Healthcare Scene readers can identify with these vendors.

This conversation stuck with me and over the spring and summer, I decided to dive deeper into the world of EHR partnerships. I wanted to know if the myths were true and I wanted to see if there were any companies that were operating differently. Over the past several months at every conference I have attended, I have made it a point to find out as much as I could about the various partnership programs and spoke with dozens of vendors who were proudly displaying partnership badges on their booths.

The good news is that there are at least two companies working hard to build a thriving partner ecosystem. The bad news is that many EHR companies do not have a well-defined partnership strategy and many vendors do not feel they are getting full value for their participation in EHR ecosystems.

One of the key things I learned is that there is a distinct difference between working with an EHR company on interoperability vs being part of their partner ecosystem. There have been many articles over the past few years about the difficulty of extracting data from EHRs in order to share it with other organizations involved in the care for patients. Headlines like “How disparate EHR systems, lack of interoperability contribute to physician stress, burnout” are common.

Many of the EHR companies I spoke with separate their interoperability efforts from their partnership programs. The ability to share data with others, they said, was not related to how well/not well they worked with 3rd party companies. So while it may be true that EHR companies have a lot of work to do on interoperability, partnership for some is something a few companies are doing well.

One company is Allscripts.

After HIMSS18, I had the opportunity to drop in on the fourth annual Allscripts Developer Summit in Chicago. I honestly did not know what to expect and I was pleasantly surprised at how intimate the event was. The rooms were smaller and had people sitting at round tables listening to presenters and asking lots of questions. The level of interaction between the speakers and the developers at the tables was refreshing to see.

Most of the attendees at the Summit were developers and product managers from companies that were Allscripts partners. Most of the discussions in the sessions and in the hallways centered around the latest APIs and FHIR initiatives.

The Summit is part of Allscript’s Developer Program (ADP). Allscripts recently announced that its ADP partners have together processed more than 4 Billion API data exchange transactions since the company started tracking it in 2013. In the announcement Tina Joros, VP and General Manager, Open Business Unit at Allscripts had this to say:

“We are trying to create a new mentality of innovation for our clients so that they view innovation as a path to improve overall workflows and connect with patients. We have made our API platform easily accessible and cost-effective for developers to use so that they can develop and test their solutions. This includes the ability for developers to use our FHIR APIs to meet regulatory requirements for our shared clients at no cost.”

I had the chance to sit down with Joros during the Summit and she shared with me that Allscripts does more than just provide access to their APIs. “We help companies with sales and marketing as well,” said Joros. “We coach partners that are new to the space how to ‘talk healthcare’. We help them craft and tell their stories to their target buyers. We spend a lot of time on the phone and in the field with our ADP partners. Our goal is to reduce the risk for clients to adopt new technology.”

With more than 8,000 registered developers in ADP, I asked Joros why so many companies had joined. “One of the key differentiators is the ADP Integrator tier of our program; most competitors have programs that make it easier to sign up for the FHIR APIs but they also have a vetting process in place to review companies for partnership,” said Joros. “In our ADP Integrator tier, however, companies can sign up immediately to access all our FHIR and proprietary API functionality – there is no wait or vetting by Allscripts and no fee to get started. The pricing model is designed so that companies only pay Allscripts when they are ready to go to market via a testing fee and usage-based fee. The ease of signing up and no fee to get started are unique in the industry.”

One company that has been very successful at working with Allscripts is Relaymed – a company that makes connectivity software that sends point-of-care test results directly into EHRs. RelayMed has been part of ADP for four years and had nothing but good things to say about the program.

“Many EHR companies have rigid cultures that actually bias them against partnerships – the ‘not invented here’ syndrome,” commented Neil Farish, CEO of Relaymed who spoke with me over the phone. “Allscripts isn’t like that. They had a vision of an open and vibrant ecosystem. That vision is ingrained into their culture and there is support right from the top. It’s become part of their DNA. If anything, senior management at Allscripts has been paying even more attention to partners this year. They are present. They interact with us. Help from their marketing & sales teams has been easy to get and really welcomed.”

The team at Relaymed has been working with the Allscripts team to tighten and improve the level of integration between their two systems. As well, the companies together are looking at ways to expand the breadth of devices that connect to Allscripts through Relaymed.

Another company that has invested in their partnership program is Cerner.

Cerner takes a different approach when working with partners. Although they have a centralized team that helps on-board partners (legal, contracting, etc), the ongoing relationship with partners is handled directly by the team/department that works most closely with that partner. Sometimes that is the Cerner sales team. Often times it is the product team. It just depends on where most of the interactions will occur.

“No partnership looks the same,” John Gresham, Senior Vice President, DeviceWorks & Interoperability at Cerner told Healthcare Scene. “So we have to ask the key question – How does that partnership bring differentiated value to the customer? We will work with partners the way that works best for our customers. That may mean embedding someone else’s solution within our solutions, co-market their solution as part of a bundle or we may simply go-to-market together.”

It was surprising to learn that a company as large as Cerner did not have a cookie-cutter approach to partnering with 3rd parties. It would have been easy for them to put in a rigid framework but instead they adapt themselves to best suit the partnership. DellEMC, Kofax and Nuance were cited by Gresham as examples of Cerner partnerships that were flourishing.

“Customers want something seamless and not just in terms of Cerner being a systems integrator for them,” continued Gresham. “They want everything to be smooth and simple – buying it, contracting it, deploying it, integrating it and supporting it. Cerner is willing to do all those things, something that isn’t common in the EHR space.”

During our conversation, Gresham repeatedly referenced Cerner’s laser focus on delivering better patient care and better outcomes – and how that focus guided their partnership decisions. In fact, that is key to attracting the attention of an internal champion at Cerner: a clear line from the product or service being offered to customer or patient benefit.

That is exactly what happened with Goliath Technologies, a provider of IT operations software that enables IT Teams to anticipate, troubleshoot and prevent infrastructure performance issues. The team at Goliath had successfully implemented their solution at a Cerner customer. That customer spoke about their experience at a Cerner event and Jay Savaiano, Senior Director of Business Development at Cerner took notice.

“It was because of Jay and his vision that Goliath got into the program,” explained Thomas Charlton, Chairman and CEO at Goliath Technologies. “He was the first person we had a conversation with and from there everything went smoothly. He was with us every step of the way and we’re still working with Jay today. But it all started because we were able to demonstrate a clear positive impact on a Cerner customer.”

“Once Cerner decided that Goliath would benefit their customers, the process of formalizing the relationship was very straightforward and smooth,” continued Charlton. “They moved really fast. They have a fantastic team of people, very competent and focused. Everyone from contracting to legal to sales was great to work with.”

Because of the success, they have enjoyed with Cerner, Goliath has begun to put a lot of focus on their partnership with Cerner. They have begun working with Cerner developers to refine and tune their combined solutions and Goliath recently hired a new VP of Corporate Development who had left Cerner a few years ago, to help strengthen the relationship [side note the VP was referred to Charlton by people at Cerner]

“Cerner brings healthcare knowledge to Goliath,” said Charlton. “They know patient care and healthcare systems management. That deep understanding of healthcare has helped us with product development. Cerner has really helped to reshape our thinking on healthcare, patient care and Healthcare IT Operations management.”


It is interesting to note that neither Relaymed or Goliath were put forward by Allscripts or Cerner respectively as example partners to speak with. Both Relaymed and Goliath were referred to me by different people who are not affiliated with either EHR company.

So if you are a software provider that is looking to partner with an EHR company what can you do to attract their attention? All four individuals I spoke with offered sage advice.

Neil Farish (Relaymed): “Avoid the transactional models of partnership where it is just an exchange of $$$. Look to the value that you as a partner are getting, the value the EHR company is getting and the value you can provide together to their end-customers. If there is value all around then the fees should be dwarfed by the value. If not, then you seriously have to rethink that potential partnership.”

Thomas Charlton (Goliath): “Have a very clear understanding of how your product or service helps deliver better care to patients. Can you show a direct line to customer or patient benefit? If you can’t then you need to figure that out before approaching an EHR company looking for a partnership. Also, joint customers are important. The more joint customers you have the more momentum you will get behind the initiative.”

John Gresham (Cerner): “The key to making partnerships work is mutual respect. That’s the starting point. Next comes a key question – do you have a ‘what’s best for customers’ mindset. If you have that then we have a foundation for conversation. I would strongly encourage companies to build solutions for the highest possible reliability, scalability and security.  Cerner customers expect that. Oh, and you have to have proof points to back that up.”

Tina Joros (Allscripts): “Be persistent. Come talk to us at conferences. Connect with us online. I would encourage any company signed up for the program and does not feel like it is providing value, to speak with a member of our team and let us know.  In some cases, we can find a tier that is a better fit for the company or make introductions to other associates at Allscripts, so additional areas of the business can evaluate their solution.”

Myth busted.

2018 Health:Further Festival Format Delivers Interesting Takeaways and a Side of Fun

Posted on September 4, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Health:Further delivered interesting takeaways from Walmart, Dell Medical School, Cerner, athenahealth & MEDITECH. The companies are bullish on data analytics, design-thinking and interoperability. Social Determinants of Health remains a challenge.

Last week, I had the chance to attend the 2018 Health:Further event (H:F) for the first time. I say event rather than conference because the latter would not do justice to the non-traditional format of the gathering in Nashville. Instead of the standard plenary+breakouts+exhibit-hall arrangement that is the norm for conferences, H:F used a music-festival approach with multiple stages in a giant exhibit hall. This was a perfect match to the unique venue – Nashville’s Music City Center.

There were four themed stages at H:F

  1. Summit of the Southeast #SOSE18 (hosted by the Tennessee chapter of HIMSS)
  2. Finances and Tokenomics (hosted by the Tennessee chapter of HFMA)
  3. Humanizing Health
  4. Clinicians and Consumers

The music-inspired multiple-stage approach allowed participants to easily and quickly move between talks. Each stage was curtained off with convenient entrances on each side of the seating area. The lack of walls and doors gave the event a dynamic and fluid feeling – with many members of the audience deciding to move to a different stage after listening to the opening statements of the session they were currently watching. Although it may have been disheartening for speakers to see people getting up to leave, in most cases there was an equal flow of people into the audience as were leaving.

Photo by AngelMD:

As a veteran conference attendee, I have no hesitation voting with my feet, but many others do not want to make a scene opening the heavy conference room doors. Most just stay put and check email while the speaker completes the presentation. Neither benefits in that situation and so the H:F organizers overcame this challenge by adopting the festival format.

Over the three days of the event, I had the opportunity to listen to thought-leaders from a number of high-profile companies including Walmart, HCA Healthcare, Dell Medical School, Mass Challenge, the Department of Health and Human Services, Cerner, MEDITECH, and athenahealth. From this outstanding lineup of speakers, several key interesting takeaways emerged.

Data analytics is yielding useful health insights

Marcus Osborne, Vice President of Health & Wellness Transformation at Walmart, spoke about the retail giant’s use of consumer purchasing to detect changes in people’s health. The company has done research on the buying patterns of its consumers and they have found that small changes in purchase behavior are strongly linked to changes in a person’s health. The data and linkage is so strong that it may be possible for Walmart to know about it before the person even has had a chance to go see their doctor!

I’m excited to see how retailers like Walmart, Amazon, Target, and others can impact health with this depth of data analysis.

Osborne also spoke about using data analytics to help drive down the cost of healthcare for it’s workforce by guiding people to higher efficacy treatments. Osborne used the term “appropriate care” when describing how data could be used to match employees with the best healthcare professional given that person’s unique health needs. The company estimates this could yield over $1Billion in savings.

Design will be a differentiator

Stacey Chang, Founder & Executive Director of the Design Institute for Health at UT Austin, challenged the audience to think seriously about the role of design in healthcare. He made the case that design-thinking and well-designed healthcare organizations (physically and from a process perspective) will be the winners as the system becomes more value-based and consumer driven.

Chang’s most thought-provoking takeaway was his statement: “To provoke change with technology – allowing humans to interact again”. That is, to truly affect change in healthcare, we need to work on technologies that bring people closer together and allow them to interact with each other, rather than with a computer screen.

Diversity leads to innovation

In one of several all-women panels, the topic of diversity and how different perspectives are needed to improve healthcare was discussed. One panelist spoke passionately about the need for healthcare to be more inclusive of everyone involved in care: patients, care-givers, clinicians, administrators, payors, employers, etc. Another panelist quickly added that diversity of industry and training was also needed – that healthcare would benefit from perspectives from outside the industry and from people with non-medical backgrounds like arts, philosophy and music.

EHR companies can get along (interoperability)

The most memorable (and lively) session at H:F happened on the Summit of the Southeast stage. The team at Tennessee HIMSS managed to get representatives from Cerner, athenahealth, MEDITECH and Medhost on a panel together to talk about interoperability. Right from the first question, we knew we were in for a fun ride:

Greg Meyer @Greg_Meyer93, Director and Distinguished Engineer at Cerner, created the most memorable moment on stage, hugging Evan Grossman who was representing athenahealth after Grossman emphatically stated that patients should “not be the mule that makes interoperability work”:

The panelists spoke at length about practical strategies to achieve interoperability – strategies that did not involve creating yet another standard, government regulations or financial incentives. The consensus of the panel was the EHR companies simply needed to get down to work and make their respective systems talk to one another because it’s the right thing to do.

No argument here.

SDOH remains a challenge

The final takeaway from H:F was that social determinants of health (SDOH) is slowly entering the consciousness of healthcare. More and more people are starting to realize and see that we cannot address health if we do not also address poverty, education, the lack of jobs, transit and food deserts. Unfortunately SDOH solutions are still in short supply. No one I spoke to had any solid ideas that would scale and everyone acknowledged this would continue to be a challenge over the next decade.

Special thanks to the Tennessee HIMSS organization for inviting me to the 2018 Health:Further event.